Common Treatments Fail to Relieve Chronic Pain

According to recent commentary, a regrettable reality is that currently available treatments for chronic noncancer pain are unable to alleviate pain or restore functioning in a majority of patients. Those observations, from a new series on pain appearing in The Lancet, highlight large gaps in the evidence base and call for more research to assess the effectiveness of combination therapies to relieve chronic pain, while ensuring that patients have realistic expectations about pain relief.

Dennis C. Turk and colleagues from the University of Washington, Seattle, observe that 20% of all persons worldwide have some degree of chronic pain, imposing a total economic burden of $210 billion in the United State alone each year [Turk et al. 2011]. They briefly review evidence for the effectiveness of the most commonly used modalities to treat chronic pain during the past decade, covering a broad spectrum: pharmacologic, surgical, interventional, physical rehabilitation, psychological, and CAM (complementary and alternative medicine).

Read more »

Misuse of Rx Pain Relievers by Young Adults

Researchers from the University of Maryland conducted a longitudinal study to examine the extent to which medication nonadherence was related to diversion of prescription analgesics by young adults. Surprisingly, more than 4 in 10 misused their pain relievers, and a quarter diverted analgesics to others, which suggests that healthcare providers need to take a stronger role in counseling young patients regarding the potential risks of noncompliance and diversion.

Reporting in the journal Pain Medicine, the authors describe a cross-sectional analyses of data from the College Life Study, a prospective survey of young adults from the time they entered a large public university in the Mid-Atlantic United States. Participants in this current investigation included 192 persons aged 21 to 26 — 50% male, 71% white — who had been prescribed an analgesic to treat acute pain in the past year.

Read more »

Does Vitamin D Relieve Pain in the Elderly?

Prior research has found that adequate vitamin D levels may play an important role in the moderation of painful conditions, and this can be of special consequence in elderly patients. A newly reported prospective, randomized, double-blind, placebo-controlled trial examined benefits of vitamin D supplementation on quality of life, functional mobility, and pain relief in the elderly. While the outcomes were favorable the conclusions to be drawn from this study are disappointing.

Researchers at the Training and Research Hospital in Adana, Turkey, enrolled 120 community-dwelling elderly subjects aged 70 years, on average, who were attending an outpatient rheumatology pain clinic for various ailments (excluding fibromyalgia but not otherwise specified) [Sakalli et al. 2011]. Subjects were randomly assigned to 4 groups of 30 subjects each; there were no differences in age or gender between the groups and one-time treatments were administered as follows (both investigators and subjects were blinded as to the actual ingredient):

Read more »

Magnetic Stimulation Therapy Aids Fibromyalgia

A research team from France and Brazil conducted the first long-term trial of repetitive transcranial magnetic stimulation (rTMS) for pain relief in patients with chronic widespread pain due to fibromyalgia. There were favorable outcomes on pain and quality of life indicators but there also were limitations of this study that must be considered.

In this trial reported in the June edition of the journal PAIN, 40 adult female patients with fibromyalgia were randomly assigned in double-blind fashion to 2 groups: one receiving active rTMS (n = 20) and the other receiving sham stimulation (n = 20), applied to the left primary motor cortex [Mhalla et al. 2011]. Subjects were all right-handed, mean age 50 years, and had experienced pain for 13.5 years on average.

Read more »

Meditation Works Through Brain to Soothe Pain

There is increasing interest in exploring nonpharmacologic and non-interventional approaches for the management of pain. According to a study reported in the Journal of Neuroscience, even a brief course in meditative techniques may significantly reduce a person's sensitivity to pain [Zeidan et al. 2011]. While there are considerable limitations in the research to date, meditation might be a viable and helpful adjunctive approach for almost any person with pain.

In the study, researchers — from the Wake Forest University School of Medicine in North Carolina and Marquette University in Wisconsin — applied a painful heat stimulus to the calves of 15 healthy men and women both before and after they attended four 20-minute mindfulness meditation training sessions during the course of 4 days. Meditating in the presence of the noxious heat stimulus significantly reduced pain unpleasantness by 57% and pain intensity ratings by 40%, on average.

Read more »

CAM Therapies for Fibromyalgia Reviewed

The June 2011 Clinical Digest from the U.S. National Center for Complementary and Alternative Medicine (NCCAM) offers a review and assessment of research on Complementary and Alternative Medicine (CAM) therapies for treating fibromyalgia syndrome. Much of the research on CAM for fibromyalgia is preliminary and evidence for the effectiveness of various modalities is for the most part limited.

Here is a summary of observations and opinions from NCCAM reviewers who assessed the literature…

Read more »

More About The FDA’s Opioid-REMS “Experiment”

As noted in a previous UPDATE [here], on April 19, 2011 the U.S. Food and Drug Administration (FDA) announced requirements of their new Risk Evaluation and Mitigation Strategy (REMS) that will apply to all long-acting and extended-release (LA/ER) opioid medications. This multi-pronged program is intended to reduce the misprescribing, misuse, and abuse of opioid analgesics. However, as more details unfold, the Opioids-REMS initiative is looking much like a rather bold experiment with potentially confounding factors and unknown outcomes.

Manufacturers of the affected products have until August 17, 2011 to submit their proposed REMS plans to the FDA for approval. On May 16, 2011, manufacturers — who had banded together in an Industry Working Group, or IWG — met with the FDA to address questions from the group that had been submitted in advance of and during that meeting. Here are some of the meeting highlights that have just been released to the public…

Read more »

Placebo Effects Foster Headache Therapy Success

Writing in the June edition of the Journal of Manipulative and Physiological Therapeutics, a research team from The Netherlands examine trials of therapies for tension-type headache and migraine to assess benefits among patients in placebo and “no treatment” control groups. Surprisingly, on average, more than a third of patients in control groups — not receiving any therapy expected to be helpful — experienced recovery from their headaches.

After examining 8 systematic reviews of randomized controlled trials published prior to 2005, the authors identified 119 trials encompassing 7,119 participants for analysis [de Groot et al. 2011]. In total, 85 trials were on tension-type headache (TTH) studying adults and children (n=5,913), and 34 were on migraine studying only children and adolescents (n=1,206). The number of participants per group ranged from 4 to 447, with a mean of about 54; a little more than a third of the studies (35.3%, mostly pharmacologic) were considered to be of high quality with low risk of bias.

Read more »

At Odds with “Odds Ratios” in Pain Research

Part 7 – Beware of Odds Posing as Risks

While the presentation of data as odds and Odds Ratios is favored by gamblers and some statisticians, many authorities on evidence-based medicine disparage their use in pain research reports as being unhelpful and potentially misleading for clinical decision-making purposes. Knowing the odds may be essential for successful betting on horse races but an understanding of how odds and Odds Ratios relate to risks and Risk Ratios is more useful for making sense of pain research. This article tells why.

The previous Pain-Topics UPDATE in this series [Part 6 here] discussed “risk statistics” — RR, RRR, ARR, and NNT — which are estimates of effect that help to put pain research into perspective for everyday practice. With a bit of study, most readers can understand and intuitively interpret risk-effect measures to decide whether a therapy or intervention might be helpful for patients with pain.

On the other hand, odds and Odds Ratios, or ORs, are somewhat like an “evil cousin”; they share a common lineage with risk-effect statistics but they are calculated differently, are not the same thing, and can be deceptive. Yet, ORs are often presented in pain research reports and confused with or wrongly interpreted as Risk Ratios.

Read more »

Radiofrequency Relieves Chronic OA Pain in Knee

In recalcitrant cases, chronic osteoarthritis (OA) pain in the knee may not be effectively managed by either pharmacologic or non-drug therapies. A more successful pain-relieving alternative in such cases might be radiofrequency (RF) ablation of certain nerves serving the knee joint, according to recently reported research.

Writing in the journal Pain, researchers from Seoul, Republic of Korea, report a randomized, controlled, double-blind trial of RF neurotomy applied to articular nerve branches (genicular nerves) for treating knee joint pain due to chronic OA [Choi et al. 2011]. The genicular complex include branches of the femoral, common peroneal, saphenous, tibial, and obturator nerves feeding into the knee joint. Radiofrequency neurotomy — sometimes used to reduce back and neck pain — uses heat generated by radio waves to destroy specific nerves and interfere with their ability to transmit pain signals. Radio waves are delivered to the targeted nerves via a probe inserted through the skin and guided into position using imaging scans.

Read more »

Treating Back Pain Reverses Brain Abnormalities

Adverse effects of chronic pain on neurobiological structure and function are increasingly being recognized due to ongoing research using brain-imaging technology. A new study helps to confirm the neuroanatomical and functional abnormalities associated with chronic low back pain, but it also offers hope that these brain changes can be reversed with effective pain therapies.

In a prospective, controlled study researchers at McGill University in Montreal, Canada, conducted structural MRI scans on 14 patients with chronic low back pain (CLBP) both before and 6 months following either spine surgery or facet joint injections for their condition [Seminowicz et al. 2011]. Additionally, 10 healthy control subjects had MRIs initially and at 6 months followup. Brain cortex thickness was assessed via structural MRI scans and subjects also performed a cognitive task during functional MRI scanning. In the report, appearing in the Journal of Neuroscience, comparisons were made between patients and controls, initially and at followup.

Read more »

Jun2011 – Pain Product Announcements & Warnings

Featured Items: ibuprofen and famotidine tablets (Duexis) approved; Bayer advanced aspirin available; intranasal ketorolac (Sprix Nasal Spray) now available — All brand names are trademarks of their respective manufacturers. Compiled by Winnie Dawson, MA, RN, BSN.

Ibuprofen and Famotidine Tablets (Duexis®) — FDA Approved
Horizon Pharma, Inc. received an April 2011 U.S. Food and Drug Administration approval for their novel fixed-dose formulation of ibuprofen 800 mg and famotidine 26.6 mg, a histamine H2-receptor antagonist used to inhibit stomach acid production. The product was approved to treat the signs and symptoms of rheumatoid arthritis and osteoarthritis while providing a potential reduction in the risk of NSAID-induced upper gastrointestinal ulcers.

Read more »